Debillon T, Sgaggero B, Zupan V, Tres F, Magny J F, Bouguin M A, Dehan M
Service de réanimation néonatale, hôpital Antoine-Béclère, Clamart, France.
Arch Pediatr. 1994 Dec;1(12):1085-92.
Assessing pain in premature babies is difficult because of their limited capacities to communicate. The aim of this study was to recognize manifestations of acute and chronic pain or, on the contrary, of well-being state, and to validate a "pain scale" for premature babies.
Premature babies less than 28 days of age (most of them less than 32 weeks of gestational age) were carefully observed during their stay in a neonatal intensive care unit by nurses, physicians, physiotherapists and a psychiatrist. All signs and symptoms were collected during situations a priori painful and compared to the behavior of the well-being states. Photographs and videofilms were also analysed.
Five items, scored from 0 to 4, were established, based on facial activity, movements and posture of the body, quality of sleep, relationship with the examiner, and efficacy of measures of comforting. These items permitted to describe four patterns corresponding to 1: well-being status, 2: acute pain, 3 and 4: durable pain or discomfort either through clinical picture of irritability or motionlessness. A strict concordance of scores for the five items between the different examiners was found in 80% of the 50 babies studied. The sensibility of the scale (studied in 12 babies) appeared accurate (77% of variation of the scores during hospitalization).
An objective assessment of pain and discomfort in premature babies can be made using a "pain scale" useful for care and therapeutic decisions.
由于早产儿沟通能力有限，评估他们的疼痛很困难。本研究的目的是识别急性和慢性疼痛的表现，或者相反，识别其健康状态的表现，并验证一种针对早产儿的“疼痛量表”。
护士、医生、物理治疗师和精神科医生在新生儿重症监护病房对年龄小于28天（大多数胎龄小于32周）的早产儿进行了仔细观察。在事先设定的疼痛情况下收集所有体征和症状，并与健康状态下的行为进行比较。还对照片和视频进行了分析。
根据面部活动、身体动作和姿势、睡眠质量、与检查者的关系以及安抚措施的效果，确定了五个从0到4评分的项目。这些项目可以描述四种模式，分别对应于：1. 健康状态；2. 急性疼痛；3和4. 通过烦躁或不动的临床表现所反映的持续性疼痛或不适。在研究的50名婴儿中，80%的婴儿在不同检查者之间五个项目的评分具有高度一致性。该量表的敏感性（在12名婴儿中进行研究）似乎准确（住院期间评分变化的77%）。
使用一种对护理和治疗决策有用的“疼痛量表”，可以对早产儿的疼痛和不适进行客观评估。
